Shock & Weight Based Calculations Flashcards

1
Q

Describe the flow of shock from Local Infection to Death

A

Local infection

Systemic infection (Early Sepsis)

SIRS (Systemic Inflammatory Response Syndrome)

Organ Failure (Severe Sepsis)

Multiple Organ System Failure
(MODS / Septic Shock)

DEATH

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2
Q

Wide spread abnormal cellular metabolism

Occurs when…

A

Gas exchange & oxygenation and tissue Perfusion needs are not meet

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3
Q

Typs of shock

Severe blood or other fluid loss makes heart unable to pump enough blood to the body

Heart cant pump effectively to pump sufficient blood to meet bodies needs

Blood vessels dilate to an extreme degree

Blood flow to the heart is blocked

Distributive, Cardiogenic, Hypovolemic, Obstructive

A

Hypovolemic
Severe blood or other fluid loss makes heart unable to pump enough blood to the body

Cardiogenic
Heart cant pump effectively to pump sufficient blood to meet bodies needs

Distributive
Blood vessels dilate to an extreme degree

Obstructive
Blood flow to the heart is blocked

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4
Q

MAP equation

A

MAP=

      3 ​
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5
Q

Normal MAP: _____

Minimum MAP for organ perfusion: ______

A

Normal MAP: 70–100 mmHg

Minimum MAP for organ perfusion: ≥ 65 mmHg

MAP Value Indicating Organ Ischemia:

MAP < 60 mmHg → Inadequate organ perfusion, leading to ischemia and organ failure

MAP < 50 mmHg → High risk of cerebral and cardiac ischemia

MAP < 40 mmHg → Possible circulatory collapse

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6
Q

Stages of Shoxk

Initial: Not noticeable

Compensatory…..

Progressive…..

Refractory….

A

Compensive: tachycardia/ Increased BP

Progressive: Compensatory Doesn’t Work/ Lower BP, Organ Dysfunction

Refractory: Irreversible Damage

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7
Q

Describe common symptoms of Shock

HR
BP
RR
TEMP
URINE OUTPUT
SKIN:
Neurological

Acidosis/ Alkalosis

A

HR: Increased
BP: Decreased
RR: Increased
TEMP: Depends (Hypovolemic = Lower / Septic = Fever)
URINE OUTPUT: Decreased / Dark Urine
Skin: Cool, pale, clammy

Neurological: Confusion/ Lethargy

Acidosis

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8
Q

IV fluids and vasopressors to increase / maintain a MAP of …..

A

> 65

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9
Q

MAP (Mean Arterial Pressure) is the average pressure in a person’s arteries during one cardiac cycle.

It is an important physiological measurement because it reflects…

A

the perfusion pressure (the pressure that drives blood flow) to the organs and tissues

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10
Q

Initial Stage of shock the baseline MAP is decreased by….

Difficult to detect at this stage

A

<10 mmhg

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11
Q

Compensatory stage

MAP decreased by….

_____ Mechanism are activated to compensate the change in MAP

Urine output decrease / Tissue Hypoxia

Subjective changes….. (2)

A

10 - 15 mmhg

Kidney & Hormonal

Thirst & Anxiety (Subjective Changes)

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12
Q

Progrssive Stage

Sustained decrease in MAP of …..

Vital organs hypoxia

Rapid, low pulse, low BP, pallor, cool, moist skin

LIFE THREATENING EMERGENCY

How long from progressive stage onset must the condition be corrected….

A

> 20 from baseline

< 1 hr

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13
Q

Refractory Stage

Too little oxygen reaches tissue cell death & tissue damage

Sequence of cell damage cuased by massive release if toxic metabolies & enzymes…..

A

MODS

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14
Q

Hypovolemic Shock CUES

(Increased or Decreased)

pH
PaO²
PaCo²
Lactic acid
Hematocrit & hemoglobin
Potassium

A

Decreased pH
Decreased PaO²
Increased PaCo²
Increased lactic acid
Increased or Decreased hematocrit & hemoglobin
Increased Potassium

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15
Q

Hypovolemic Shock

If vasoconstrictor medications (like norepinephrine or epinephrine) Extravasation occurs from IV and necrosis occurs

What is the medication treatment….

A

Phentolamine (Regitine)

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16
Q

Causes of this type of shock……

Pump failure

  • MI
    -Dysrhythmias VT VF
  • Cardiomyopathy

Treatment (4)

A

Cardiogenic shock
Oxygen delivery CPAP

Decrease Preload

Enhance contractility
- Milrinone
- Dobutamine

Dilation of coronary vessels
- Nitroglycerin
- Nitroprusside

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17
Q

To treat Cardiogenic shock related to unable to pump sufficient

Give Oxygen CPAP
Decrease Preload

Give these medications to

Enhance Contractility…

Dilate Coronary Vessels….

A

Enhance Contractility
-Milrinone
- Dobutamine

Dilate Coronary Vessels
-Nitroglycerin
-Nitropruside

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18
Q

Cardiac Tamponade
PE
Tension Pneumothorax
Tumors

May cause this type of Shock

A

Obstructive

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19
Q

Loss of sympathetic tone
Blood vessel dilation
Vascular leakage

Lead to Distributive Shock

Management

Airway O² / Intubation

Drugs… (2)

A

Epinephrine

Diphenhydramine

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20
Q

Causes of this shock are

Neurological

Chemically induced
Anaphylaxis
Capillary leak
Sepsis

A

Distributive

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21
Q

1 Mortality in ICU

1 million pts a year

20 billion dollars / 5% Healthcare $$$$

Mortality rate…

Issue…

A

28 - 50%

Sepsis

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22
Q

Infection

Normal response

____ Arteries & ____ Veins to increase blood flow.

Neutrophils, Monocytes, Macrophages attack

Local swelling dilates microorganisms & Toxins

A

Dilation of arties & Constriction of veins increase blood flow

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23
Q

Sepsis is an over response or a systemic response

Uncontrolled (3)

A

Inflammation
Coagulation
Fibrinolysis

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24
Q

The qSOFA score is based on three clinical criteria:

Respiratory Rate ≥ 22 breaths per minute
(Increased respiratory rate may indicate respiratory distress or failure.)

Altered Mental Status
(Any change in mental status, such as confusion, disorientation, or lethargy, can be an early sign of sepsis or organ dysfunction.)

Systolic Blood Pressure ≤ 100 mmHg
(Low blood pressure is an indicator of poor circulation and possible shock, which is common in sepsis.)

What is a Clinical Identiation….

A

2 or more

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25
Q

3 criteria for qSOFA
Quick Sequential/ Sepsis Organ Failure Assessment

Score of 2 or more is concerning

A

Respiratory Rate ≥ 22 breaths per minute
(Increased respiratory rate may indicate respiratory distress or failure.)

Altered Mental Status
(Any change in mental status, such as confusion, disorientation, or lethargy, can be an early sign of sepsis or organ dysfunction.)

Systolic Blood Pressure ≤ 100 mmHg
(Low blood pressure is an indicator of poor circulation and possible shock, which is common in sepsis.)

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26
Q

Norepinephrine (Levophed)
Epinephrine (Adrenaline)
Dopamine
Phenylephrine (Neo-Synephrine)
Vasopressin (Pitressin)
Dobutamine
Metaraminol
Angiotensin II (Giapreza)

This type of medication…

This effects…

A

Vasopressor

Increase BP by construction of blood vessels

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27
Q

Septic shock, serum lactate levels can be elevated due to the impaired oxygen delivery to tissues and cells.

Why elevated lacate levels…

Elevated lactate levels are a marker of tissue hypoperfusion and anaerobic metabolism.

A

When tissues are deprived of sufficient oxygen, they rely on anaerobic metabolism, which produces lactic acid as a byproduct

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28
Q

Normal Lactate Levels: Typically, normal serum lactate levels are between……

Mild Elevation: Lactate levels between ______ may indicate early signs of shock or inadequate perfusion, though patients can still be clinically stable.

Severe Elevation: Lactate levels _____ often associated with septic shock and a more severe state of hypoperfusion, indicating significant tissue oxygen deprivation.

A

Normal 0.5 - 1

Mild Elevation 2-4 mmol/L

Severe Elevation: >4 mmol/L

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29
Q

Resuscitation Bundle

Septic Shock

With in …….

Vasopressor (Norepinephrine / Levophed)

Administered how….
Frequent BP monitoring/ GOAL MAP >65

A

6 hrs

Vasopressor administered via Central Line

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30
Q

Septic shock

Reassess volume status & tissue Perfusion

Measure CVP target 8 -12

Central Venous Pressure
Superior vena cava or right atrium, reflecting the blood volume returning to the heart (preload) and the heart’s ability to pump it effectively.

What do highs and lows from this indicate….

Measure SvO Target 70%

SvO₂ Percentage of oxygen bound to hemoglobin in the mixed venous blood (typically measured in the pulmonary artery). It reflects the balance between oxygen delivery (DO₂) and oxygen consumption (VO₂).

Use….

A

High CVP: Suggests fluid overload, right-sided heart failure, or increased intrathoracic pressure.

Low CVP: Indicates hypovolemia (low blood volume), dehydration, or severe vasodilation.

Use of SVO²

SvO₂ is used to monitor oxygen delivery and consumption, especially in critically ill patients. A decrease in SvO₂ often signals worsening shock or inadequate tissue perfusion, while an increase may indicate a mismatch between oxygen delivery and consumption.

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31
Q

Procalcitonin is a valuable biomarker in Septic Shock for diagnosing bacterial infection

What is a normal Procalcitonin level….

A

Normal <0.15 ng/mL

Increased means bacterial infection

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32
Q

Additional therapy for Septic Shock.

  1. Which respitory condition will call for the use of Mechanical Ventilation…
  2. Insulin for BS ….
  3. Are DVT prophylaxis used (Lovenox & SCD)
A
  1. ARDS
  2. > 180
  3. Yes
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33
Q

Sepsis Quality Indicators

Resuscitation Bundle completed in…

Describe 3 facotrs in the bundle…

A

3 hrs

  1. Serum lactate levels (>2 = lack of oxygen to the cells)
  2. Blood culture before Abx.
  3. Abx started within 3 hrs of ED admission/ 1 hrs. Inpatient
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34
Q

Resuscitation Bundle

How long until Abx are started

ED / Inpatient

A

ED 3 hrs

Inpatient 1 hr

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35
Q

Resuscitation Bundle

With in 6 hrs

Fluids / Vasopressor to maintain map _____

Lactate this level ____

SvO² this level _____

A

Map >65%

Lactate < 2

SvO2 >65%

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36
Q

Management Bundle of Sepsis at 24 hrs

Prevent infection
Control _____
DVT & stress ulcer prophylaxis

A

Blood Glucose

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37
Q

Decreased perfusion and GFR ___ URINE OUTPUT

Potential complications…

A

Lowered

Obligaría then anuria

ATN / Kidney Failure

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38
Q

Early & late Manifestions in Neuromuscular system…

A

Early: Anxiety/ Restlessness

Late: Lethargy, Weakness, Decreased DTR

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39
Q

Cardiovascular

CO….
HR….
Pulse….
Orthostatic hypotension Early
Steadily decreased BP
___ VEINS

A

Decrease CO
Increased HR
THREADY PULSE
FLAT VEINS

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40
Q

PULMONARY

RR…
Paco² & O²
Pallor, Waxy, Cyanosis
Potential ARDS

A

Increased RR
Increased PaCo² & Decreased O2

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41
Q

GI

Bowel Sounds & Motility….
NV
Thirst
Describe BS early & late

A

Bowel sounds/ Motility Decreased

Early elevated BS & Late Hypoglycemia

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42
Q

Integumentary

Pale/ Mottled
Cool
Moist/ Clammy
Dry mouth

Late…

A

Edema

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43
Q

Name Organ

Removes old / bad RBC & WBC

Recycling center for blood cells

A

Spleen

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44
Q

Name Organ

Stores RBC & Platelets

A

Spleen

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45
Q

Name Organ

Produces blood cells

A

Bone marrow

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46
Q

Hemostasis - Describe 4 parts

A

Vascular Spasm (Vasoconstriction)

Damaged blood vessel constricts to reduce blood flow.

Triggered by nerve reflexes and chemicals like endothelin.
Platelet Plug Formation

Platelets adhere to exposed collagen in the vessel wall.

Activated platelets release signals (ADP, thromboxane A2) to recruit more platelets.
Platelets stick together, forming a temporary plug.

Coagulation (Clot Formation)

Clotting factors activate the coagulation cascade.

Prothrombin → Thrombin, which converts Fibrinogen → Fibrin.
Fibrin forms a stable mesh, reinforcing the platelet plug.

Clot Retraction & Fibrinolysis

Clot contracts to close the wound.
Plasmin breaks down the clot after healing is complete.

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47
Q

Men: 4.7 – 6.1 million cells per microliter (μL) of blood

Women: 4.2 – 5.4 million cells/μL

Children: 4.1 – 5.5 million cells/μL

A

Red Blood Cells (RBCs)

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48
Q

Normal range: 4,000 – 11,000 cells/μL

Low WBC (Leukopenia): Below 4,000 cells/μL

High WBC (Leukocytosis): Above 11,000 cells/μL

A

White Blood Cells (WBCs)

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49
Q

Normal range: 150,000 – 450,000 platelets/μL

A

Platelets (Thrombocytes)

Low Platelets (Thrombocytopenia): Below 150,000 platelets/μL

High Platelets (Thrombocytosis): Above 450,000 platelets/μL

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50
Q

Describe integumentary system with Anemia…

A

Pale/cool skin

Brittle nails

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51
Q

MCV (Mean Corpuscular Volume)

Is…..

A

MCV measures the average size of red blood cells (RBCs) and is used to classify different types of anemia.

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52
Q

Normal Range: 80–100 fL (femtoliters) per RBC

Low MCV (<80 fL): ….(Types of Anemia)

High MCV (>100 fL): Macrocytic anemia (e.g., vitamin B12 (Cobalamin) or B9 (Folate) deficiency)

A

Low <80 Microcytic anemia (e.g., iron deficiency anemia, thalassemia)

High >100 Macrocytic anemia Vitamin B12 or folate deficiency

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53
Q

With Sickle cell anemia describe process of Sickle cell crisis…

Describe triggers…

Priority interventions….

A

Painful episode that occurs when sickle-shaped red blood cells block blood flow, leading to severe pain, organ damage, and complications.

Dehydration, infection, stress, cold temperatures, or low oxygen levels.

Pain
Hydration
Oxygen
Infection
Blood transfusion

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54
Q

The following are different types of what disease….

Vaso-occlusive crisis (most common) – Severe pain due to blocked blood flow.

Aplastic crisis – Reduced RBC production, leading to severe anemia.

Sequestration crisis – RBCs trapped in the spleen, causing hypovolemic shock.

Hemolytic crisis – Rapid destruction of RBCs, causing jaundice and anemia.

A

Types of Sickle Cell Crises:

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55
Q

Describe the D5W IV for Sickle Cell crisis….. Rate & Flow

A

D5W.45 @ 250mL - 4hrs then
125mL /Hr

56
Q

Describe Washed RBC and use….

Give over this time….

A

Plasma, WNC & Platelets removed to prevent allergic reactions to transfusion.

Give over 2 - 4 hrs

57
Q

1 unit of platelet raises value by…

58
Q

Is compatibility ABO matching needed for platelets…

59
Q

How long of transfusion time to give platelets…

Patient is having chills during transfusion, nurses response….

A

15 - 30 min

Chills normal reaction. Continue to assess

60
Q

Plasma component of whole blood, frozen within 8 hours of collection to preserve clotting factors. It contains water, electrolytes, albumin, fibrinogen, and coagulation factors (I, II, V, VII, VIII, IX, X, XI, XIII, and protein C & S).

No RBC / WBC

A

Fresh Frozen Plasma (FFP)

61
Q

Coagulation factor deficiencies (e.g., liver disease, DIC, massive transfusion).

✅ Reversal of Warfarin (Coumadin) toxicity when Vitamin K is too slow.

✅ Massive bleeding or trauma requiring clotting factor replacement.

✅ Thrombotic thrombocytopenic purpura (TTP) – To replace ADAMTS13 enzyme.

✅ Disseminated Intravascular Coagulation (DIC) – To restore clotting factors.

Indication for…

62
Q

Administration of FFP

✔ Dose: Typically 10–15 mL/kg (around ____ units in adults).

✔ Infusion Rate: Over ______ per unit (must be used within 24 hours after thawing).

✔ Blood Compatibility: ABO matching is ( required/ not required)
Rh matching is not necessary.

A

4–6

30–60 minutes

ABO required

63
Q

Cryoprecipitate is a component of plasma that is rich in clotting factors

Used for….

A

Von Willenbrand Syndrome

Bleeding Disorders

64
Q

Albumin is a protein found in human plasma that plays a key role in maintaining oncotic pressure (the osmotic pressure exerted by proteins in the blood)
Transporting substances (like hormones, drugs, and waste) Regulating fluid balance in the body.

Human albumin is commonly used in medical settings as a ______

Normal value…

A

Plasma volume expander

3.5 - 5

65
Q

The universal donor for red blood cells is ______ , as it has no A, B, or Rh _____, making it compatible with any recipient.

A

O negative

Antigens

66
Q

The universal recipient for red blood cells is _______ as they can receive blood from any ABO and Rh type

A

AB positive (AB+)

67
Q

Type A blood has _____ antibodies, so receiving type B blood will cause an immune response

68
Q

Type O- blood, with no A, B, or Rh ( Antibodies / Antigens), is the universal donor because it won’t provoke an immune reaction

while ____ is the universal recipient because they have no antibodies against A, B, or Rh antigens.

A

Antigens

AB+

69
Q

Why can’t a person with blood type B+ receive blood from a person with blood type A-?

A

blood type B+ cannot receive blood from a person with blood type A- because they would have antibodies against the A antigen, which would cause a reaction.

70
Q

Transfusion Reaction

Hemolytic

Describe

____ HR
____ RR
____ BP

Describe Febrile reaction…

A

Increased HR / RR

Decreased BP

Febrile: SAME VS + Chills / Rapid Onset of Sepsis

71
Q

Circulatory Overload from transfusion
Pounding JVD & BP

When to give Lasix…

A

Between Blood Units

72
Q

Cefepime
Cetfriaxone
Piperacillin / tazobactam
Levofloxacin
Meropenem
Ampicillian / sulbactam
Aztreonam

A

Antibiotics to treat Sepsis

73
Q

Antibiotics to treat Sepsis (9)

A

Cefepime
Cetfriaxone
Piperacillin / tazobactam
Levofloxacin
Meropenem
Ampicillian / sulbactam
Aztreonam

74
Q

Type of breathing treatment used for ARDS….

A

PEP

Positive expiture pressure

75
Q

MOD

Multiple Organ Dysfunction

Key SS….

A

Disseminated Intravascular Coagulation (DIC) – Uncontrolled clotting and bleeding due to excessive consumption of clotting factors and platelets.

Thrombocytopenia (Low Platelets) – Increased risk of bleeding and impaired clot formation.

Hemolysis (Destruction of Red Blood Cells) – Leads to anemia, hypoxia, and organ damage.

Leukopenia or Leukocytosis – Abnormal white blood cell count, affecting immune response.

Severe Anemia – Decreased red blood cell levels, impairing oxygen delivery to tissues.

Hypoperfusion and Ischemia – Impaired blood flow leading to tissue and organ damage.

76
Q

Indications for HgbA Transfusion in MODS: (3)

Nursing Considerations: Infusion Fast or Slow… How much Fluids…..

A

Severe anemia (Hgb < 7 g/dL, or symptomatic anemia)

Tissue hypoxia despite oxygen therapy

Hemorrhagic shock or active bleeding
Impaired oxygen delivery contributing to organ failure

NURSING CONSIDERATIONS

Slow infusion / 4L

Baseline & Continuous Monitoring: Vital signs, oxygen saturation, urine output, and signs of transfusion reactions.

✔ Slow Transfusion Rate: Typically 1-2 mL/kg/hr, adjusting based on the patient’s status.

✔ Pre-medications if Needed: Antihistamines or acetaminophen for patients with a history of reactions.

✔ Monitor for Signs of TRALI/TACO: Dyspnea, crackles, increased JVP, or decreased SpO₂.

✔ Electrolyte Management: Check calcium, potassium, and acid-base balance post-transfusion.

77
Q

_____ Genetic blood disorder characterized by defective hemoglobin production, leading to chronic anemia.

Mutations in the genes responsible for defective hemoglobin synthesis

The severity depends on whether the person has the minor (carrier), intermedia, or major (severe form requiring lifelong transfusions).

Affects Asians,African, Mediterranean

A

Thalassemia

78
Q

Risk level for an infant with Thalassemia Major….

A

Thalassemia Major (Cooley’s Anemia) –

High Risk

Severe life-threatening anemia developing within a few months after birth.

Requires lifelong blood transfusions and iron chelation therapy.
High risk for iron overload, heart failure, infections, and growth retardation.

Maybe dead in 1 year

79
Q

Hemolytic anemia is a condition in which red blood cells (RBCs) are destroyed (hemolysis) faster than they can be produced, leading to anemia and oxygen delivery problems.

It can be inherited (genetic) or acquired (due to external factors like autoimmune disorders.

Name 2 diseases we talked about that fit this description…

A

Sickle Cell & Thalassemia

80
Q

Vitamin B12 deficiency anemia, also known as _____ anemia when caused by lack of intrinsic factor, occurs when the body does not have enough vitamin B12 (cobalamin) to produce healthy red blood cells.

This leads to macrocytic anemia, neurological complications, and impaired DNA synthesis.

A

pernicious

81
Q

Causes

Causes of …..

Dietary deficiency (strict vegan/vegetarian diet)

(autoimmune destruction of gastric parietal cells → lack of intrinsic factor)

Gastrointestinal disorders (Crohn’s, celiac, gastric bypass, chronic gastritis)

Medications (metformin, proton pump inhibitors, H2 blockers)

Chronic alcohol use (impairs absorption)

A

Pernicious anemia (Lack of vitamin B12)

82
Q

_____ anemia is a rare but serious condition where the bone marrow fails to produce enough red blood cells (RBCs), white blood cells (WBCs), and platelets, leading to pancytopenia (low levels of all three blood cell types).

83
Q

Causes of Aplastic Anemia

A

Idiopathic (Unknown)
Viral
Radation
Auto immune disorder
Medications

84
Q

Type of conditions that require Whole Blood transfusions….

A

Massive hemorrhage 30 - 40% blood volume / Hypovolemic Shock

Surgery

Injured Soldiers

85
Q

PRB - Packed Red Blood Cells

Restore RBC’s Enhance Oxygen, without giving high volume of blood

T or F

86
Q

How long to infuse PRBC…..

1 unit increases hemoglobin….

Do you need to check ABO compatibility with PRBC….

A

Infuse PRBC 2 - 4 hrs

1 unit increases hemoglobin 1 gram

Yes, check compatibility

87
Q

Sepsis Checklist Provider

0 - 3 hrs

A

Lactate levels
Blood culture
IV ABX
IVF if… SBP < or MAP <65 or Lactate > 4 30cc / kg crystalloid fluids

88
Q

Provider
In first 3 hours when EC Sepsis Order Set Utilized:

Lactate levels
Blood culture
IV ABX

IVF if….

A

IVF if… SBP < or MAP <65 or Lactate > 4 30cc / kg crystalloid fluids

89
Q

RN responsibilities first 3 hours of EC Sepsis Order Set Utilized

A

Obtain labs (Lactate & Blood Culture)

Adminster broad spectrum ABX, After Culture has been collected.

Document 2 BP within 1 hr of fluid completion (1 within first 15 minutes)

90
Q

Obtain labs (Lactate & Blood Culture)

Adminster broad spectrum ABX, After Culture has been collected.

Document 2 BP within 1 hr of fluid completion (1 within first 15 minutes)

Which Time Frame for a Sepsis Pt.

A

Within 1st 3 hours

91
Q

RN responsibilities for hours 3 - 6

A

Repeat Lactic Acid

Adminster Vasopressor, if ordered

Text Report to RMF floor charge nurse prior to transfer. Cal report to ICU/Progressive. ID pt as ECCS pt.

Provide checklist to floor for continuation of care

92
Q

Main producer of many clotting factors….

93
Q

Breaksdown RBC. (Organ)

Converted into…

A

The liver is the primary organ responsible for breaking down hemoglobin.

When red blood cells are recycled, the liver processes the heme portion of hemoglobin into biliverdin, which is then converted to bilirubin. The bilirubin is eventually excreted in bile and helps in the digestion of fats.

94
Q

Hormone primarily produced by the kidneys, although a small amount is also produced in the liver.

It plays a crucial role in regulating the production of red blood cells ________ in the bone marrow.

______ is released in response to low oxygen levels in the blood (hypoxia) and stimulates the bone marrow to increase red blood cell production, helping to improve oxygen delivery to tissues.

A

(erythropoiesis)

Erythropoietin

95
Q

(Mean Corpuscular Hemoglobin) is a measure of the average amount of hemoglobin in a red blood cell

Describe how Low & High

A

Low MCH (hypochromia)
Iron deficiency
Anemia
Thalassemia
chronic blood loss, where there is less hemoglobin in each red blood cell.

High MCH (hyperchromia)

macrocytic anemia, where red blood cells are larger than normal, such as in Vitamin B12 or Folate deficiency.

96
Q

When exposed to _____ ,Hbs change RBC cell from round to Sickle shape

97
Q

Sickle Cell

Cells clump, block blood flow, cause tissue hypoxia and organ damage.

_____ problem corrected, will return to somewhat normal shape

98
Q

Describe body system with Sickle Cell

Pain

CV

Skin

Abd

MS

CNS

CBC

A

Pain: Abdomen, back, legs, joints

CV: absent or distant pulses

Skin Cyanosis/ Leg Ulcers

Abd Firm enlarged liver

MS Pain degenerate changes

CNS Stroke / seizures

CBC Increased WBC

99
Q

Are IV opioid appropriate with Sickle Cell…

A

Yes, First 48 hrs + PCA

Then oral meds

100
Q

Detection of Sepsis Temp how often

101
Q

Multiple Organ dysfunction

Transfusions

Increase HgbA levels but can cause overload in…

102
Q

Treatment for Thalassemia (3)

A

RBC transfusion
Chelation Therapy
Bone Marrow Transplant

103
Q

______ is a medical treatment used to remove heavy metals (such as lead, mercury, arsenic, or iron) from the body. It involves the administration of chelating agents—substances that bind to metal ions—allowing them to be excreted through urine or feces.

Used for which disorder we discussed….

A

Chelation therapy

Thalassemia

104
Q

Glucose 6 Phosphate Dehydrogenase Deficiency is associated with….

A

Hemolytic anemia

105
Q

Iron deficiency anemia

  1. Take with this vitamin for absorption
  2. Stools this color
  3. Use Z track for IM Injections
  4. SE:
A
  1. Vitamin C
  2. Dark green / black
  3. Hypotension, flushing, anaphylaxis
106
Q

Uses: Treatment of megoblastic and maxrocytic anemia….

A

Folic acid

107
Q

Uses: Pernicious anemia & Cyanide Poisoning

Lifelong replacement required

May turn skin / urine red for 2 -5 weeks

A

Vitamin B12

108
Q

SS of this anemia include

Petechiae/ ecchymosis

Treatment….

A

Aplastic

Blood transfusion/ antibiotics & antifungal to Replace & Support missing RBC & WBC

109
Q

Hgb transfusion threshold

Acute MI….

Heart disease…..

No heart disease….

A

Acute MI 9 -10

Heart disease <8.7

No heart disease <7.7

110
Q

Can an A blood type recoeve blood from an AB donor…

A

No but an AB can recieve blood from an A ( Or anyone else)

111
Q

Are 2 nurses needed to verify a prescription for blood products….

112
Q

Use proper filtered tubing to transfuse blood.

How long to stay with patient afterwards….

A

VS q15H 1st hour

Atleast first 30 minutes of infusion

113
Q

Describe what is being replaced / why

RBC

Platelet

Plasma

A

RBC: RBC lost from trauma / Surgery

Platelet low count <150,000, active bleeding, scheduled invasive procedure

Plasma Replaces blood volume & clotting factors

114
Q

Hemolytic transfusion Reactions happen due to…

A

ABO / Rh incompatibility

115
Q

Type of Transfusion Reaction

Urticaria, itching, bronchospasm

Rapid onset of sepsis

116
Q

Normal hemoglobin / crit levels for men.

A

Men: 13.8–17.2 g/dL

40 - 52% hemocrit

117
Q

Nomral hemoglobin/ crit levels for women…

A

Women: 12.1–15.1 g/dL

35 - 47% hemocrit

118
Q

Can A + recieve A - blood?

Can A - recieve A + blood?

A

A+ can recieve A -

But

A- cannot recieve A+

119
Q

Cardiac Output =

A

Stroke volume (Ejected with each contractions)

×

HR

120
Q

_______ is a group of diseases that affect the heart muscle, leading to structural and functional abnormalities.

It can result in heart failure, arrhythmias, and sudden cardiac death.

A

Cardiomyopathy

121
Q

Most common type

Cause: Genetics, viral infections, alcohol, chemotherapy, or idiopathic

Pathophysiology: The heart chambers (especially the left ventricle) enlarge and weaken, reducing pumping ability

Symptoms: Fatigue, shortness of breath, swelling, irregular heartbeat

A

Dilated Cardiomyopathy

122
Q

Diagnosis of Cardiomyopathy… (4)

A

Echocardiogram (Echo) – Assesses heart structure and function

Electrocardiogram (ECG) – Detects arrhythmias

MRI or CT scan – Provides detailed imaging

Genetic Testing – Identifies inherited cardiomyopathies

Biopsy (Rarely) – Evaluates muscle tissue

123
Q

Medications

Devices

Life style changes

Surgery

For cardiomyopathy

A

Medications: Beta-blockers, ACE inhibitors, diuretics, anticoagulants

Implantable Devices: Pacemakers, ICDs (for arrhythmias)

Lifestyle Changes: Low-sodium diet, exercise (as recommended), avoiding alcohol

Surgical Options: Septal myectomy (for HCM), heart transplant (for severe cases)

124
Q

The primary site of hematopoiesis, where all blood cells are produced (RBCs, WBCs, platelets).

Red marrow, found in flat bones and the ends of long bones, is responsible for making new blood cells.

The marrow contains stem cells that differentiate into various blood cell types.

A

Bone Marrow

125
Q

Filters the blood, removing damaged or old RBCs and platelets.

Stores blood cells, particularly platelets, and releases them when needed.

Plays a role in immune response by producing WBCs and filtering pathogens from the blood.

Has a role in recycling iron from old RBCs.

126
Q

Produces important plasma proteins like albumin, clotting factors (fibrinogen, prothrombin), and others that are essential for blood volume, clotting, and immunity.

Stores iron and vitamin B12, important for RBC production.

Breaks down hemoglobin from old RBCs and recycles components like iron.

Produces fibrinogen, which is vital for blood clotting.

127
Q

Involved in the maturation of T-lymphocytes (T-cells), which are essential for the adaptive immune response.

Helps train these immune cells to distinguish between self and foreign invaders, ensuring they don’t attack the body’s own cells.

128
Q

Filter lymph fluid and trap pathogens, debris, and cancer cells.

House WBCs, particularly lymphocytes (T-cells, B-cells), which are essential for immune responses.

Serve as sites for immune cell activation and proliferation.

A

Lymph nodes

129
Q

Purpose: Used to evaluate for immune hemolytic anemia. The direct test detects antibodies attached to RBCs, while the indirect test assesses circulating antibodies.

130
Q

Test for anemia include

CBC
Hemoglobin (Hgb): Low levels indicate anemia.

Hematocrit (Hct): The percentage of blood volume occupied by RBCs, which decreases in anemia.

Red Blood Cell Count (RBC): Helps assess the overall number of RBCs.

Mean Corpuscular Volume (MCV): Measures the average size of RBCs. It helps classify anemia (microcytic, normocytic, or macrocytic).

Mean Corpuscular Hemoglobin (MCH) and Mean Corpuscular Hemoglobin Concentration (MCHC): Help assess the amount of hemoglobin per RBC.

Iron Studies

Purpose: Helps evaluate the most common causes of anemia (iron deficiency):

Serum Iron: Measures the amount of iron in the blood.

Vitamin B12 and Folate Levels

Purpose: To assess whether deficiencies in these vitamins are causing macrocytic anemia.

Deficiencies can lead to impaired RBC production.

What are Healthy levels of
MCV
MCH
Serum Iron
B12
B9 Folate

A

(MCV)
Normal Range: 80–100 fL

(MCH)
Normal Range: 27–33 pg (picograms) per RBC

Serum Iron: 60 - 170

B12 200–900 pg/mL

B9 Folate 3.0–17.0 ng

131
Q

Pain crises, anemia, stroke, organ damage

Anemia, jaundice, iron overload, bone deformities

Sickle Cell or Thalassemia

A

Pain crises, anemia, stroke, organ damage (Sickle Cell)

Anemia, jaundice, iron overload, bone deformities (Thalassemia)

132
Q

Vaso-occlusive crises, stroke, infections, spleen dysfunction

Iron overload, heart failure, bone deformities

Sickle Cell or Thalassemia

A

Vaso-occlusive crises, stroke, infections, spleen dysfunction
Sickle Cell

Iron overload, heart failure, bone deformities
Thalassemia

133
Q

Pain management, hydroxyurea, blood transfusions, bone marrow transplant

Blood transfusions, iron chelation therapy, bone marrow transplant

Thalassemia or Sickle Cell

A

Pain management, hydroxyurea, blood transfusions, bone marrow transplant
Sickle Cell

Blood transfusions, iron chelation therapy, bone marrow transplant
Thalassemia

134
Q

Distributive Shock: 3 Types

Severe vasodilation causing blood pooling

A

(Includes Septic, Neurogenic, and Anaphylactic Shock)

135
Q

Distributive shock includes Septic Shock, Anaphylaxis, and neurogenic shock.

Describe treatment…

A

Treat underlying cause (antibiotics for sepsis, epinephrine for anaphylaxis, vasopressors)